American doctors prescribe more drugs for blood pressure, get lower readings than Europeans

CHICAGO -- High blood pressure is controlled better in the United States than in five Western European countries, a study found, and researchers credit American doctors' more aggressive prescribing of drugs.

The researchers pointed proudly to the findings, saying that the U.S. strategy of prescribing more pills earlier probably saves money overall by preventing heart attacks and strokes.

But other experts disputed that and questioned the cost-effectiveness of treating mildly high blood pressure.

The study was conducted by researchers at the University of Pennsylvania, University of Chicago and Stanford University and was published in Monday's Archives of Internal Medicine.

The researchers looked at doctors' reports on more than 21,000 patients treated for hypertension. They found that post-treatment blood pressure was 134 over 79 on average in the United States; 139/80 in France; 141/83 in Germany; 143/84 in Italy; 141/83 in Spain; and 144/82 in Britain.

A reading of 140/90 or above is considered high, both in America and abroad. High blood pressure raises the risk of a heart attack, stroke, heart failure and kidney failure.

The study also found that the use of more than one blood pressure drug per patient was highest in the United States, with 64 percent of the patients getting more than one class of drug. That compared with a low of 44 percent in Spain and 59 percent in Germany and Britain.

High blood pressure affects more than 72 million adults in the United States, according to the American Heart Association, and Americans will spend $23 billion on blood pressure drugs this year.

American doctors follow more aggressive treatment guidelines for high blood pressure than do doctors in Europe. The U.S. guidelines encourage prescribing medicine earlier and adding additional medications if one pill alone does not work.

The study's authors wrote that spending on blood pressure drugs in the United States is probably less than the costs of the heart attacks and strokes prevented.

"That's very debatable," countered Dr. William Elliott of Chicago's Rush University Medical Center, an expert on preventive medicine. "Only in specific subsets of patients does it save money ... for very high-risk people, older people, people with previous heart attack and strokes."

Also, the study does not take into account the potential harmful side effects of aggressive medical treatment for hypertension, said Dr. Lisa Schwartz of the VA Outcomes Group, made up of researchers trying to promote the straightforward presentation of medical information. Blood pressure drugs can cause low blood pressure (which can lead to falls), weakness, depression and chronic cough.

In addition, some experts said the study simply reflects the fact that American doctors are treating less-severe hypertension to start with. The Europeans in the study started with higher blood pressure before treatment.

For example, 87 percent of the French started with levels over 160/100. In contrast, 65 percent of Americans started treatment with levels that high.

Also, the study did not involve a representative sample of the nations' people, but instead looked only at those people who go to the doctor for hypertension. That means the study probably missed uninsured Americans who cannot afford regular care.

The data came from a 2004 survey in which doctors filled out diaries about the first 15 cardiovascular patients they saw in one week.

The study was supported by grants from the National Institute on Aging and the Agency for Healthcare Research and Quality. The authors reported no financial ties to the drug industry.

---

On the Net:

Archives: http://www.archinternmed.com